Innovative approaches to Medicaid expansion within the Medicaid managed care delivery system

Much attention has been paid to innovative approaches to coverage of the Medicaid expansion population that leverage the private commercial insurance market for coverage through “premium assistance” programs. However, other states have turned to the Medicaid managed care delivery system as the vehicle for implementing innovative coverage designs for the newly eligible population. As outlined below, these states have received 1115 Medicaid Demonstration waivers to gain flexibility in the coverage offered to this population via managed care plans. [More]

Alabama’s Regional Care Organization 1115 waiver approval

In May 2013, Act-2013-261, Ala. Code §§ 22-6-150 was passed, advancing the move from a fee-for-service (FFS) system to a managed care program. According to the Alabama Medicaid Advisory Board report issued in January 2013, based on 2011 data, 22 percent of Alabama’s population was Medicaid eligible for a portion of the year. Additionally, Alabama’s Medicaid program covered 53 percent of births, 47 percent of children, and two-thirds of nursing home residents. In 2009, Medicaid accounted for 16.3 percent of all health care expenditures in Alabama. In order to contain costs associated with the substantial Medicaid population, managed care in the form of regional care organizations (“RCOs”) were established with little guidance other than the Act 2013-261 itself. [More]

CMS announces the release of $22 Million in Health Insurance Enforcement and Consumer Protections grant funding

On June 15, 2016, the Centers for Medicare and Medicaid (CMS) announced the release of $22 million in grant funding for State planning and implementing of the health insurance market reform provisions of the Affordable Care Act (ACA). The grants are aimed at helping States ensure their laws, regulations and procedures are in line with Federal requirements and that the States are able to effectively monitor and enforce health insurance market reforms and consumer protections under the ACA. States must submit a letter of intent by July 6th. Grant applications are due August 15th at 3:00 pm. [More]

KFF estimates significant increases in Exchange premiums for 2017

On June 15, 2016, the Henry J. Kaiser Family Foundation (KFF) released a report entitled, “Analysis of 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces.” The report estimates that premiums on Federal and State-based Exchanges will rise in 2017 at about twice the rate of increase for 2016 and that insurer participation in Exchanges will decline. KFF compared final 2016 premiums versus proposed 2017 premiums for major cities in 13 states and the District of Columbia (the geographic areas for which KFF could access complete 2017 rate filings for all insurers planning to participate in Exchanges in 2017). Insurers’ proposed 2017 premiums will be subject to review by state insurance departments and may be adjusted following state review. [More]

Michigan district aims to build leadership with Principal’s Playbook

On June 20, 2016, an article in eschoolnews.com highlighted one Michigan school district’s efforts to build its principals’ leadership and data literacy skills. PCG’s Education Consulting team partnered with the Saginaw School District to support this professional development initiative by implementing PCG’s blended learning platform, Principal’s Playbook. [More]

Family First Act - A Closer Look

PCG Human Services has partnered with the Alliance for Strong Families and Communities to create a detailed summary of the Family First Prevention Services Act, which is under consideration by the US House and Senate. This bill would expand Title IV-E funding for certain services to children and families that aim to prevent a child’s placement into foster care. The bill also changes how Title IV-E reimburses states for costs associated with children who are placed in child caring institutions and reauthorizes several existing child welfare federal grants. [More]

New white paper examines implications of the Department of Labor’s Final Rule

The Fair Labor Standards Act of 1938 (FLSA) sets standards that affect workers in all industries, including federal benchmarks and protections for minimum wage, child labor, discrimination and overtime. The regulations that pertain to overtime were recently revised through the Department of Labor’s Final Rule that was published on May 23, 2016 (and effective December 1, 2016) [More]

CMS awards grants to promote children’s enrollment in Medicaid and CHIP

On June 13, 2016, the Centers for Medicare and Medicaid Services (CMS) announced $32 million in grant awards supporting innovative strategies to enroll and retain children in Medicaid and the Children’s Health Insurance Program (CHIP). Innovation awardees include 38 state, local, and provider-based organizations in 27 states, such as the Los Angeles Unified School District (involving multi-lingual outreach information at over 800 district sites), the Bexar County Hospital District in Texas, and the Refuah Health Center, Inc. in New York State. [More]